| NPI | 1154851079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2022-01730) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 64059) |
| 207Y00000X Otolaryngology (Licence: MN 28449) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-12-12 |